Communicating with someone who has delusions

A delusion is a fixed false belief that can't be swayed by reasoning. Paranoid, grandiose, and religious delusions are most common. A paranoid delusion is very frightening: The person thinks someone is out to harm him. Acknowledge what he says but don't agree. For example, if your patient tells you that the FBI is after him, hone in on his feelings: "Sensing that you're being watched all the time must be very frightening."

Keep your patient's environment as safe as you can. Try to have the same staff assigned to his care each day and prepare him for any changes without providing too many details; for example, "Mr. Jones, we're getting some new patients today so we have to move you to a different room." If he responds negatively, reassure him that he'll be safe and you'll protect him.

Grandiose and religious delusions are typically less frightening. A person having a grandiose delusion, for example, thinks he's someone very powerful or important. Someone with a religious delusion may claim to be a religious figure.

Follow these guidelines to maintain a therapeutic relationship with your patient:

• Accept him as he is. His mental illness is causing his abnormal perceptions.
• Monitor for hallucinations and delusions to assess his response to psychotropic medications.
• Assess his safety and monitor for warning signs such as withdrawal and depression.
• Give him appropriate feedback on how you interpret his communications and try to help him focus on the realities around him.
• Encourage him to learn about his medical illness and help with his care; involve him with diversions such as reading, writing, or solving puzzles. These activities can diminish irrational thinking and help him feel comfortable and safe.

Responding to disorganized speech

Classic verbal disturbances that might occur with schizophrenia include associative looseness, neologisms, clang association, word salad, and echolalia.

Associative looseness means one thought isn't connected to the next. When you tell your patient you've brought his medication, he might reply, "Blue lights and gold. I go round and round. The grass is green." These phrases seem disconnected but could shed light on his thoughts. If you suspect that the colors are significant, ask, "Are you asking what different medications you're getting here?" If you can't make a connection, tell him you don't understand but you'll keep trying.

Dr Smita Pandey Bhat, Clinical Psychologist, Gurgaon, Delhi - NCR, INDIA

dr.smitapandey@gmail.com 

http://child-psychologist.blogspot.com

Few days back a person came to me with the complaints that he is not able to concentrate on his work anymore. He had sleepless nights and that he lost pleasure in most of the things he used to like. Also, he used to feel sad, gloomy and irritable all the time. He felt that his life is not worth living and that he should die. All the time he felt tired and low in energy. What is this person suffering from?

The answer is depression.

The people in depression feel sad, tired and low in energy all the time. They are usually not able to concentrate on their work. Either they sleep very less, wake up early in the morning or they sleep too much and feel like not getting up in the morning. The time becomes hard for them to pass as they feel very gloomy and sad. They lose pleasure in their surroundings and feel that it is very difficult for them to stand the day.

Since the arrival of the day is very painful to them they feel very difficult to get up in the morning. Even if they are not feeling sleepy they lie in the bed as the arrival of another day is not welcoming anything new to them. They feel low in energy all the time and not able to enjoy their day to day usual activities. Sometimes they feel like crying and they actually cry a lot. Most of the time they feel that they are no good, they cannot do anything well and that they are worthless.

They cut themselves of from the social circle because they have lot of shame and guilt about themselves not performing well. They feel helpless because of moving away from the society. They feel hopeless as all the things appear to them as gloomy and that they feel that the life has come to an end and that there is no hope in their life. Sometimes they think of committing suicide as well because they feel hopelessness in their lives. Sometimes they plan to take suicidal actions. Mostly people do not act on these plans but sometimes they actually does act over these plans.

So you need to be very careful if someone related to you is suffering from these problems. The treatment for depression is the medications and psychotherapies. The medications involve several antidepressants which try to ward off depression. The idea behind medications is that prolonged stress can make neuro chemical changes in the brain which might cause some changes in emotions and behavior.

The response to stress is a fight or flight reaction. Either you try to maintain your behavior through fighting it off or you try to avoid these situations or run away from the situation. For example if a snake comes through your way you will be frightened and you will undergo a lot of emotional changes resulting in the fighting behavior (to kill the snake) or the flight behavior (running away from the place). You experience these emotions due to changes in the chemicals in your brain.

But these emotions become permanent if the stress is prolonged as these chemicals cause derangements in your brain. Taking medications from outside would try to maintain your equilibrium. The medications would try to release either those chemicals in your brain which release those neurotransmitters that are healthy for you or try to block those neurotransmitters that are unhealthy for you. Psychotherapies like cognitive behavior therapy focus on the thinking style (cognitions).

It believes in the concept that the thinking style affects your emotions and behavior. If you start thinking positive then your emotions and behavior will be positive and if you think negative then your behavior and emotions will be negative and you will feel sad and gloomy all the time. So it is all about your perceptions - how you perceive the world.

For example do you feel the glass is half "empty" or half "filled". The therapist try to validate your thoughts from the reality, he/she try to focus on the evidences that what evidences are there which makes your assumptions and automatic thoughts. Then therapist gives you lots of homework’s and a schedule of activities to keep yourself busy all the time so that you do not find it difficult to kill time and that you are engaged constructively which can bring back your zeal and enthusiasm towards life. Therapist acts as a support towards all the activities you do and he/she tries to encourage the person who is depressed.

One thing I would like to add here is that the antidepressants and the Cognitive Behavior therapies might be used separately but when they are used in combination, the results and benefits are more effective. Please find out if anybody related to you is suffering from these symptoms and try to help him or her. You may contact your nearest clinical psychologist and psychiatrist for the advice.

Dr. Smita Pandey Bhat
Clinical Psychologist Delhi
Email : dr.smitapandey@gmail.com
Url : http://child-psychologist.blogspot.com